1997 AAP/ACOG “Guidelines for Perinatal Care” recommends antenatal transfer to a Subspecialty center (level 3) for preterm labor and impending delivery at gestational age <32 wks. Based on our regional population based perinatal database (1982-1991), we reported that infants with birth weights 500-999 gms had an increase in the probability of birth at a Subspecialty center (p<0.001) and a decreased neonatal mortality(p<0.005) (Ped. Res. 33.4). There was an overall decrease in neonatal mortality for infants with birth weights 1000-1499 gms whether they were cared for exclusively at a Specialty (level 2) center (p<.005) or all or part at a Subspecialty center (p<.001) (Ped. Res.35.4). Because of the increased availability of neonatologists and perinatologists at Specialty centers in Cincinnati, we evaluated neonatal mortality from 1982-1996 among 1000-1499 gm infants by site of birth. Mean annual live births are 29,271 with 0.66% weighing 1000-1499 gms, range (0.55%-0.77%). Using logistic regression, there was a decrease in neonatal mortality over time as expected (p<.0001) and controlling for the effect of time, there was a decrease in neonatal mortality by site of birth (p<.01). Of the 302 infants born at Basic (level 1) or Specialty centers, 46% subsequently were transferred to a Subspecialty center. Only 1.7% of births 1000-1499 gms were born at Basic centers. Despite the increased availability of neonatologists at Specialty centers, our data supports antenatal transfer of mothers <32 wks gestational age with preterm labor and impending delivery. Table

Table 1 No caption available.
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